| NPI | 1912392341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: OK 37000) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 94-08839) |
| 208000000X Pediatrics (Licence: MO 2018019408) | |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2022-03-29 |